Republicans' Plan to Repeal Healthcare?

[Ivan Seeking]

http://www.pnhp.org/news/2010/march/politicians-didn%E2%80%99t-get-it-right

as pro single payer I hate this health reform bill, as a business owner I hate it more.

As a small business owner, I love it because it makes health insurance affordable where it never was before. The biggest single impediment to most people considering opening a small business is the cost of health insurance.

As a small business, won't you receive a subsidy to offset the cost of insurance? Also, the cost for companies that don't comply is, I thought, more like $2000 per employee. There have been a lot of numbers tossed around over the last few days, but I thought that was the penalty. Perhaps that is only for larger companies?

My feeling is that this bill is a pig, but it's the only pig in town. After 70 years of failed attempts, if this hadn't passed, it may have been a very long time before any significant reform was seen. With that in mind, isn't it better to pass this and amend as needed, rather than allowing the current system to continue indefinitely?

I too would have preferred a single-payer system. Apparently that was too big of a step for now. I guess that one comes down to Senator Snow's vote in the senate... and the two Independents.

 

[drankin]

Perhaps the government could create universal eateries. No more people going hungry. It would improve health overall and create an equality of food quality for everyone. We would only be allowed healthy food at these eateries and we would only be allowed our rations every day. What we eat could be determined by experienced and trained professionals employed by the government at no direct cost to us. We would still have other places to eat, but these places would be taxed as "Cadillac eateries". In the end this would result in lower health care costs, and also reduce if not eliminate the number of people who don't have enough to eat. No more obesity for the United States. (In fact taxes would be higher for the obese as their increased wait is a greater burden on everyone else.) We could lead the charge against hunger as a nation.

This is crazy. Can you reference any government programs that support that this would be even mildly successful? Providing free healthy food is not going to prevent obesity. It will just give people more food to eat. Healthy food can make you fat too.

 

[Dembadon]

Perhaps the government could create universal eateries. No more people going hungry. It would improve health overall and create an equality of food quality for everyone. We would only be allowed healthy food at these eateries and we would only be allowed our rations every day. What we eat could be determined by experienced and trained professionals employed by the government at no direct cost to us. We would still have other places to eat, but these places would be taxed as "Cadillac eateries". In the end this would result in lower health care costs, and also reduce if not eliminate the number of people who don't have enough to eat. No more obesity for the United States. (In fact taxes would be higher for the obese as their increased wait is a greater burden on everyone else.) We could lead the charge against hunger as a nation.

This is a false analogy.

Many U.S. citizens band together and cook food for the homeless/hungry on a regular basis. However, one cannot set up a tent and start handing out insurance policies to those who need them. You don't need to own a food company to feed someone.

 

[Count Iblis]

So if the Republican party regain control of the house and senate, are they able to reverse the bill?

They need a 2/3 majority to overturn a veto from the President. If Repbublican candidates were to run on an agenda of overturning the health care bill, they will only get votes from conservatives.

 

[Count Iblis]

Perhaps the government could create universal eateries. No more people going hungry. It would improve health overall and create an equality of food quality for everyone. We would only be allowed healthy food at these eateries and we would only be allowed our rations every day. What we eat could be determined by experienced and trained professionals employed by the government at no direct cost to us. We would still have other places to eat, but these places would be taxed as "Cadillac eateries". In the end this would result in lower health care costs, and also reduce if not eliminate the number of people who don't have enough to eat. No more obesity for the United States. (In fact taxes would be higher for the obese as their increased wait is a greater burden on everyone else.) We could lead the charge against hunger as a nation.

Homeless shelters already offer free of charge food.

 

[Ivan Seeking]

They need a 2/3 majority to overturn a veto from the President. If Repbublican candidates were to run on an agenda of overturning the health care bill, they will only get votes from conservatives.

Note also that a majority of Americans support health care reform. 59% of Americans oppose this bill, but 13% do because it doesn't go far enough. That stats suggest that we may well see as much as 55% approval by next November.

Just try to sell people on the idea that we now want to effectively cancel insurance for sick children who were previously refused insurance due to preexisting conditions.

 

[adrenaline]

As a small business owner, I love it because it makes health insurance affordable where it never was before. The biggest single impediment to most people considering opening a small business is the cost of health insurance.

As a small business, won't you receive a subsidy to offset the cost of insurance? Also, the cost for companies that don't comply is, I thought, more like $2000 per employee. There have been a lot of numbers tossed around over the last few days, but I thought that was the penalty. Perhaps that is only for larger companies?

My feeling is that this bill is a pig, but it's the only pig in town. After 70 years of failed attempts, if this hadn't passed, it may have been a very long time before any significant reform was seen. With that in mind, isn't it better to pass this and amend as needed, rather than allowing the current system to continue indefinitely?

I too would have preferred a single-payer system. Apparently that was too big of a step for now. I guess that one comes down to Senator Snow's vote in the senate... and the two Independents.

The tax benefits won't offset the half a million a year I pay, and this reform bill made no provisions for the insurance company to not raise their premiums ( which they will since I now have to provide coverage for all children of employees until 26 years of age and more dependants). If I was a small business hurting and looking to cost overhead, it would be easier to dump my employees onto the public exchange and fend for themselves. That is the bottom line. Also, I have always felt it was unfair that I have to pay more in premiums just becau se my employees are predominantly female.

we needed a change yes but this pig is out of control . I already have a bloated clerical staff just to deal with 300 plus private insurances, I honestly don't see my self opeining myself up to twice that number by accepting the public exchange. My partners have already foreseen the beaurocratic nightmare.

 

[Brian_C]

They need a 2/3 majority to overturn a veto from the President. If Repbublican candidates were to run on an agenda of overturning the health care bill, they will only get votes from conservatives.

They will get plenty of votes from people who either got nothing from this bill, lost their employer provided coverage, or saw their premiums skyrocket as a result.

I think the Tea Party crowd actually helped the Dems pass this bill. They were able to argue that the bill represents real reform because all the 'evil right wingers' were against it. Reality is about to smack the American people right in the mouth.

 

[Ivan Seeking]

The tax benefits won't offset the half a million a year I pay, and this reform bill made no provisions for the insurance company to not raise their premiums ( which they will since I now have to provide coverage for all children of employees until 26 years of age and more dependants). If I was a small business hurting and looking to cost overhead, it would be easier to dump my employees onto the public exchange and fend for themselves. That is the bottom line. Also, I have always felt it was unfair that I have to pay more in premiums just becau se my employees are predominantly female.

I know that insurance companies will now be required to disperse 80% of the funds collected, for claims. So they do not have the option to arbitrarily raise prices without providing addtional coverage. At least, that's the theory as I understand it.

 

[Pattonias]

Is there any reason we couldn't pass insurance reform without the public option? Is anyone arguing that the reforms were not necessary? The biggest hang ups on the bill were over the universal public insurance option.

 

[calculusrocks]

Perhaps the government could create universal eateries. No more people going hungry. It would improve health overall and create an equality of food quality for everyone. We would only be allowed healthy food at these eateries and we would only be allowed our rations every day. What we eat could be determined by experienced and trained professionals employed by the government at no direct cost to us. We would still have other places to eat, but these places would be taxed as "Cadillac eateries". In the end this would result in lower health care costs, and also reduce if not eliminate the number of people who don't have enough to eat. No more obesity for the United States. (In fact taxes would be higher for the obese as their increased wait is a greater burden on everyone else.) We could lead the charge against hunger as a nation.

Doesn't Hugo Chavez do something like this in Venezuela?

 

[adrenaline]

I know that insurance companies will now be required to disperse 80% of the funds collected, for claims. So they do not have the option to arbitrarily raise prices without providing addtional coverage. At least, that's the theory as I understand it.

I will let you know , I just hope they don't raise their premiums over the next four years in a last hurrah...

 

[adrenaline]

Is there any reason we couldn't pass insurance reform without the public option? Is anyone arguing that the reforms were not necessary? The biggest hang ups on the bill were over the universal public insurance option.

This bill has no public option, only the insurance exchange where our federal tax dollars will now subsidize the private insurers like cigna, humana , blue cross etc etc. It's corporate welfare. They are trying to tack on an amendment but I'm sure it's not going to pass.

 

[calculusrocks]

adrenaline, is retirement an option in your situation?

 

[turbo]

I already have a bloated clerical staff just to deal with 300 plus private insurances, I honestly don't see my self opeining myself up to twice that number by accepting the public exchange. My partners have already foreseen the beaurocratic nightmare.

My cousin codes for a pediatric ophthalmologist who has many, many clients on Medicaid. The doc (who is also a friend of mine) doesn't mind the lower reimbursement rates because the coding for public insurance is very straightforward, and they don't delay and deny payments over and over again. That's very important for a small practice, because cash-flow problems and aged receivables can sink a small practice. When I was IT manager for a very large ophthalmic practice, one of my constant/recurrent duties was to identify insurance companies that were delaying or denying claims, resulting in receivables that were 60-90 days old. Banks don't like to extend your line of credit based on aged receivables like that. In my experience, it was the private insurance companies that caused 99% of the trouble by changing coding requirements, and kicking back any claims that were not properly coded to THEIR requirements, regardless of how many other insurance companies would have accepted the coding as submitted. We had three full-time coding experts for an in-house staff of 10-12 doctors, and those ladies were busy.

 

[adrenaline]

My cousin codes for a pediatric ophthalmologist who has many, many clients on Medicaid. The doc (who is also a friend of mine) doesn't mind the lower reimbursement rates because the coding for public insurance is very straightforward, and they don't delay and deny payments over and over again. That's very important for a small practice, because cash-flow problems and aged receivables can sink a small practice. When I was IT manager for a very large ophthalmic practice, one of my constant/recurrent duties was to identify insurance companies that were delaying or denying claims, resulting in receivables that were 60-90 days old. Banks don't like to extend your line of credit based on aged receivables like that. In my experience, it was the private insurance companies that caused 99% of the trouble by changing coding requirements, and kicking back any claims that were not properly coded to THEIR requirements, regardless of how many other insurance companies would have accepted the coding as submitted. We had three full-time coding experts for an in-house staff of 10-12 doctors, and those ladies were busy.

Your right, I tell people medicare pays me less but i probably spend 3 dollars for every 100 dollars i collect on clerical work and probably spend 33 dollars for every 100 i collect from private insurance. Most of us polled want single payer ( NEJM, JAMA) poll after poll shows most docs will take less payment just to deal with a more streamlined , consistent, single payer than the beurocratic garbage we have to deal with now.

How is this for a statistic, Duke Medical Center has 500 hospital beds and 500 full time coders, one coder per bed, what do you think the nursing ratio is?

 

[adrenaline]

adrenaline, is retirement an option in your situation?

No, I love what I do. Even though I have paid my student loans, I practice internal medicine in an area where there are so few of us left ( we have nine doctors who take call at the hospital for 45 docs who won't come to the hospital anymore ) that there would be a critical shortage of care if I retired. We see all the unsassigned , indigent patients and other docs patients along with ours that it is getting to be a nightmare but the situation is not getting better as more students owing half a million are going into lucrative interventional radiology, dermatology etc.

 

[turbo]

Your right, I tell people medicare pays me less but i probably spend 3 dollars for every 100 dollars i collect on clerical work and probably spend 33 dollars for every 100 i collect from private insurance. Most of us polled want single payer ( NEJM, JAMA) poll after poll shows most docs will take less payment just to deal with a more streamlined , consistent, single payer than the beurocratic garbage we have to deal with now.

That's something that the GOP and the blue-dogs don't want to happen for some reason. Health care costs could drop like a rock with a single payer system because medical practice overhead would plummet. Also, if you had a single coding guide-book and coding standard to deal with, not only would your administrative staff be much smaller, you wouldn't have to pay to re-educate them over and over as insurance companies come up with new ways to deny payment. Getting regular payments on claims (even at reduced reimbursement rates) would be a boon to private practices. As you might imagine, advances in ocular surgeries often come with some very $$$$ equipment. If you'd like to add new surgical laser to a new field office (we did!) your line of credit with the bank had better be healthy. That can be tough when you have receivables that are aged 2-3 months or more because the insurance companies deny and delay, and make you recode and re-submit. Meanwhile those insurance companies are investing that "float" and making money at the expense of medical practitioners.

This bill should have radically reformed health-care insurance. It did not. The health-care system in this country is struggling under the weight of massive bureaucracy imposed by the insurance companies, who often have regional monopolies. Progressives and true fiscal conservatives should join with willing members of Congress and keep fighting for a single-payer option. If the private insurers can't or won't compete, then they should get out of the business. The bill as passed is a boon to the insurance companies who get millions of new customers, many of them healthy, without reducing rates.

 

[adrenaline]

the PHNP says we will save 400 billion a year if we go single payer.
I opt for single payer with privatized secondary insurance.

 

[turbo]

the PHNP says we will save 400 billion a year if we go single payer.
I opt for single payer with privatized secondary insurance.

That would be ideal. Let every citizen buy into Medicare, and the younger, healthier people would reduce the experience rate of the older members. That would immediately reduce the payout per patient, and save Medicare some really big money, while keeping it solvent. If you want private insurance instead of or in addition to the public coverage, you buy it.

Somehow, the fiscally-attractive options to the status-quo are not seriously considered on the Hill. If we follow lobbyists' money, I'm pretty sure we'll know why. Congress' constituency only includes us when they want our votes, and after the election, they do the bidding of the men with the money.

 

[mheslep]

I know I linked to this in another thread, but it fit here too. http://www.frumforum.com/waterloo".

That part of Frum's essay I think is a silly strawman. What would be proposed is a replacement bill, not a go-back-to-the-way-it-was repeal.

 

[adrenaline]

Somehow, the fiscally-attractive options to the status-quo are not seriously considered on the Hill. If we follow lobbyists' money, I'm pretty sure we'll know why.

I believe the insurance lobby is the second most powerful, both dems and repubs have their pockets lined by them. That's why no public option and instead federally funded 30 million new clients for the insurance industry in the exchange. Oh Obama, you were pro single payer as a senator, now you kow tow to the industry, you let me down...

 

[mheslep]

Can the law be overturned some other way? There are two - one is that the law needs to survive a court challenge. I think it will, after Wickard v. Fillburn, but one can never tell.

W v F was a stretch it was, and this health mandate is different in that the health consumer is just that - a consumer not producing any saleable product unlike that wheat farmer. There are constitution limits on what the government can mandate. To make this law fly, the Dem's would have had to offer up some kind of rule that strikes a balance, that is maintains a balance, between the government's commerce regulation authority and the citizen's right to otherwise be left alone. Instead, their argument is that we need the mandate to make health care pay off, health care is a good thing, therefore the mandate is legal, which amounts to little more than the 'we want it that way' legal argument. If their logic holds, some examples of where the government can go next on the same basis:

• As it is in the national interest to have a large domestic auto manufacturing capability, IF you buy a car, it shall be a GM made car, unless you reside in Nebraska, Florida, Louisiana, or Montana.
• As it is in the national interest to have a well informed citizenry, you shall purchase a daily newspaper. Qualifying newspapers will be listed on a national exchange.
• As it is in the national interest to promote science and engineering education, all graduates of science or engineering academic programs or those with long work experience in these fields shall purchase a two year subscription to Physics Forums.

Edit: Here's the summary position of the Florida AG's suit:

Florida’s lawsuit will make three claims: that Congress lacks the authority to require individuals to buy health insurance; that the penalty for those who do not buy health insurance violates the U.S. Constitution’s tax-apportionment clause; and that the legislation violates the 10th Amendment by granting the federal government new powers.

http://blogs.wsj.com/law/2010/03/23/back-to-tallahassee-health-bill-suit-starts-taking-shape/

 

[mheslep]

Do you have a reference for an estimate of the risk? The CBO has released estimates projecting decreases in the deficit over the next 10 years.

See cost estimates: http://www.cbo.gov/publications/collections/health.cfmhttp://www.cbo.gov/publications/collections/health.cfm

Here's the right link, I think, for what you intended:
http://www.cbo.gov/publications/collections/health.cfm

The question is for what did CBO release a projection? The current reconciliation bill http://www.cbo.gov/doc.cfm?index=11376&type=1" Yes, that's the number, but is that 'health care'? Well for the first four years it is all taxes and no/little benefits, so I'd say no in that respect it is not 'health care'. Then there are other kitchen sink items thrown into 4872 such as the student loan program to make the bill's $numbers look better, but student loans are not health care either.

In any case, the actual health care part seems to have an total price tag of about $1 trillion over ten years. The bill pays for that with about $500B in new taxes, and by $500B in cuts to Medicare, both also over 10 years, without a corresponding change to Medicare's obligations. The problem of course as shown in the CBO main link that http://www.cbo.gov/publications/collections/graphics/health3.gif" . I see no way out of the US defaulting on Medicare obligations with current policy.

 

[mheslep]

This bill does nothing to prevent my carrier from raising premiums 178% like it has over the ten years I have been partner.

Not so. The bill has many provisions that theoretically allow the government to reject any insurer rates it doesn't like, though that doesn't mean the government will do so. I expect the decision will be completely political, just as are current utility rates.

Information about Insurance Plan Expenditures, and a Rebate to Assure Value
o Each year, insurers will report the percentage of Americans’ premiums they spend on items other than health care costs, such as bureaucracy, marketing, or executive compensation.
o Americans will receive a rebate if their health insurer’s non-medical costs exceed 15 percent of premium costs in the group market or 20 percent in the small group and individual market. Using cost data from this year, rebates will begin in 2011 and the policy applies to all insurance plans.
[...]
Protection from Exorbitant Out-of-Pocket Costs
o Insurance companies will abide by yearly caps on what they may charge beneficiaries for out-of-pocket expenses, like co-payments or co-insurance charges. This will ensure that Americans are not forced to file bankruptcy due to high health care costs.
 Notification and Justification of Premium Increases
o Insurers will be required to publicly disclose the amount of any premium increase prior to the increase taking effect, and to provide a justification for the increase. This will limit the industry’s current practice of hiking up insurance rates in order to push less healthy individuals and small businesses off their rolls.

http://dpc.senate.gov/healthreformbill/healthbill54.pdf

 

[mheslep]

Also, I have always felt it was unfair that I have to pay more in premiums just becau se my employees are predominantly female.

That's also gone. The only justifications now allowed for rate differential are age, family composition, geography, and tobacco. Period.

 

[adrenaline]

That's also gone. The only justifications now allowed for rate differential are age, family composition, geography, and tobacco. Period.

But not right away.
I read that the insurance exchange would prohibit the sale of policies that discriminate on the basis of gender, this ban would not apply to companies with more than 100 employees until 2017.
It almost sounds as if it is only for insurance offered on the insurance exchange? Or am I misreading it?

 

[mheslep]

But not right away.
I read that the insurance exchange would prohibit the sale of policies that discriminate on the basis of gender, this ban would not apply to companies with more than 100 employees until 2017.
It almost sounds as if it is only for insurance offered on the insurance exchange? Or am I misreading it?

hmm, dunno, I missed that caveat. It may be exchange insurance only.

 

[adrenaline]

Not so. The bill has many provisions that theoretically allow the government to reject any insurer rates it doesn't like, though that doesn't mean the government will do so. I expect the decision will be completely political, just as are current utility rates.http://dpc.senate.gov/healthreformbill/healthbill54.pdf

That is the problem, I don't trust the government to look out for me as a small business. What might be low insurance rate hike for a interventional radiologist with less overhead and less clerical personell is exponentially higher for primary care operating on razor thin profit margins.

 

[mheslep]

That is the problem, I don't trust the government to look out for me as a small business. What might be low insurance rate hike for a interventional radiologist is exponentially higher for primary care operating on razor thin profit margins.

Neither do I. But then why on Earth would you favor single payer which entirely cedes all financial health care authority to the government?

 

[turbo]

Neither do I. But then why on Earth would you favor single payer which entirely cedes all financial health care authority to the government?

Go back to post #50 and read an exchange of information from people who have been intimately involved in the business-aspects of private medical practices.

If you get your information from politicians, lobbyists, and talking-heads, you will be sadly misinformed. I have spent years in the business, as has adrenaline, and we know what economic forces have the most leverage on medical practices. Sadly, health-care reform was turned into a political football, with no rational discourse regarding the economic advantages of single-payer systems.

 

[adrenaline]

Neither do I. But then why on Earth would you favor single payer which entirely cedes all financial health care authority to the government?

probably because i have had less problems with medicare than most , but not all, private insurances.

And, I want to be back in the business of being a doctor, right now, running a business with a majority of employees in the non medical field, thinking up ways to keep our business solvent, yet needing so many personell to check insurances to figure out where I can run the labs ( quest vs labcorp vs inhouse labs), where to send for MRI, will their insurance pay for open MRI down the street, hiring extra MAs just to do precerts, prior auths etc. it takes the joy out of medicine. I am most at home just changing vent settings in the ICU or putting a chest tube in a collapsed lung, not listining to my office manager tell me how I have to code better, how to keep track of drug formulaies, listining to phone calls telling me I have to change a drug prescription because it used to be on the formulay but now it's not etc. At least with Medicare, I deal with one single set of rules and regulations. And honestly, I've never had to deal with a gum popping knucklehead begging them for an MRI in a person with a fever of 102 and loss of anal wink ( since I suspect spinal abscess) and telling me it will be another four hours before they can give me the approval.

It is all the above that a majority of us favor single payer.

Don't get me wrong, there are private insurances that are a joy to deal with but it is far and few between.

 

[turbo]

Don't get me wrong, there are private insurances that are a joy to deal with but it is far and few between.

Whatever insurance company covers Maine teachers was pretty darned good. One of my oldest, dearest friends was deeply in love with a teacher, and when he noticed her dropping parts of her daily routines (like laying out clothes for the next school day), he talked to her sister, and they got her checked out. Glioblastoma. Generally a death-sentence with a 6 month term or less. The insurance company paid for tests, re-tests, surgery, radiation, etc... Linda lasted over a year, and though she had her ups and downs, we got to visit with her at home, take her soups and stews, home-made breads, etc. Her insurance company didn't drop her, restrict treatment, etc.

 

[jbunniii]

I know I linked to this in another thread, but it fit here too. http://www.frumforum.com/waterloo".

That's a pretty amazing essay. It illustrates the mindset of a political strategist, who might be the only species on Earth who could write both of these things regarding the same bill:

"Conservatives and Republicans today suffered their most crushing legislative defeat since the 1960s.

It’s hard to exaggerate the magnitude of the disaster."

and

"But we do know that the gap between this plan and traditional Republican ideas is not very big. The Obama plan has a broad family resemblance to Mitt Romney’s Massachusetts plan. It builds on ideas developed at the Heritage Foundation in the early 1990s that formed the basis for Republican counter-proposals to Clintoncare in 1993-1994."

So the plan is more or less what their own party wanted in 1993-1994, but its passage is now a disaster? Why is it a disaster? Because their party chose to oppose it so militantly and it passed anyway? Well, whose fault is that?

And WHY did they choose to oppose it so militantly if they actually agreed with most of its tenets? Why didn't they negotiate and compromise like grown-ups do, particularly grown-ups who are in the minority party? They could have steered the bill to align it even more closely with their interests, and then they could declare a victory not only for their conservative principles but also their bipartisan ethos.

Instead they held their breath until they turned blue like big ol' babies. No wonder so many people consider our political system to be completely broken.

 

[Nebula815]

I suggest you look up the CBO report on the legislation that was passed, and they will put out another report on the amendments once they make their way through the Senate.

Like I said, the CBO is wrong; there is just no way they can accurately calculate something like this.

Do you have any links to support your claim that the CBO is wrong?

You don't need any official links for that one. It is basic common sense. They double-count Medicare, and furthermore, there is no example of any government healthcare program paying for itself that this nation has created. Even in Europe, many of the programs are heavily in debt, like France, they are having to ration within the UK, etc...

Just because the CBO says something will work doesn't mean it will, you might as well have meteorologists trying to predict the weather years from now.

The CBO has to rely on a lot of assumptions, regarding economic growth, that there won't be any big recessions further in the future, etc...

Like I've said before, it is the policy equivalent of engineering a brand-new jumbo jet, and then rather than build a few prototypes and test them, you just have a group of the best engineers analyze all the parts, the whole design, and "calculate" whether the plane will fly or not.

Well they can compute and calculate till the cows come home, you don't put the aircraft into production until you actually build a few versions and start flying them to see how all the parts function together.

But we are doing the policy equivalent of just this, engineer the jumbo jet then throw it into production. Sure, theoretically it will fly, reality is a whole different ballgame!

And thus far, the previous jets we have put into production have all crashed, or are headed towards crash.